An employer who wishes to self-insure for disability and Paid Family Leave can apply for the privilege to self-insure in New York. Employers may apply to self-insure for disability only, or disability and Paid Family Leave together, but may not self-insure for Paid Family Leave only.
An employer who wishes to self-insure for disability benefits only, or disability and Paid Family Leave benefits together, must submit the following as part of the application process:
- Application for Self-Insurance - Disability Benefits Law (Form DB-150)
- Foundation documents (i.e. certificate of incorporation; partnership agreements; etc.); and
- A copy of the applicant's most recent independently audited financial statement.
If the Office of Self-Insurance notifies an applicant that conditional approval is granted, the applicant must submit the following
- Signed and notarized Agreement and Undertaking for Paying Benefits as A Self-Insurer - Disability and Paid Family Leave Benefits Law (Form DB-152);
- Security deposit in a form prescribed by the Chair; and
- Other documentation as necessary
The initial amount of the security deposit will be based, in part, on the number of covered employees. The current minimum-security deposit is
- $10,000.00 if self-insured for disability only
- $11,000 if self-insured for disability and Paid Family Leave
The Office of Self-Insurance will notify an applicant of final approval if all conditions are met. Every year that the employer remains self-insured, the security deposit is reviewed for adequacy, based in part on changes in covered employee count. Employers must adjust their security deposit to adequate levels as determined by the Board.
For more information about the self-insurance application process please contact the Office of Self-Insurance at SelfInsurance@wcb.ny.gov
Surety Bond with Electronic Signatures
The New York State Electronic Signatures and Records Act (ESRA) gives electronic signatures and electronic records used or accepted in New York State the same legal validity and effect as hand-written signatures and paper-based records, subject to certain exceptions stipulated in ESRA. In accordance with ESRA, an electronic signature is an electronic sound, symbol, or process, attached to or logically associated with an electronic record and executed or adopted by a person with the intent to sign the record. An electronic signature is "attached to or logically associated with an electronic record" if the electronic signature is linked to the record during transmission and storage.
Surety Bonds with electronic signatures that comply with the provisions of ESRA, are acceptable to the Board and legally binding. The Board has determined that the following surety bond and rider forms will be accepted with electronic signature:
- DB-179 (Self-Insurer's Surety Bond);
- DB-179.1 (Surety Bond Rider); and
- DB-179A (Self-Insurer's Surety Bond - Additional Affirmations).
Such forms must: (1) be complete and correct, with no alterations to language or content; (2) must be executed using a certificate-based signature, using Adobe Acrobat or Adobe Reader; and (3) be properly acknowledged by a Notary Public, in accordance with NYS requirements for Electronic Notarization which require that the Notary Public be physically present in the State of New York.
To sign a document with a certificate-based signature, an individual must obtain a digital ID or create a self-signed digital ID in Adobe Acrobat or Adobe Reader. Additional instructions for executing a document electronically, using Adobe Acrobat or Adobe Reader to create a certificate-based signature can be found on Adobe's Certificate-based signatures page.
More information regarding electronic signature can be found in the Electronic Signatures and Records Act (ESRA) document, located on the New York State ITS website.
Please note that while the Board is accepting surety bond forms with electronic signature, use of electronic signatures is not required. Printed Bonds with wet ink signatures will still be accepted.
Annual Reporting Requirements
While actively self-insured, each employer must submit the following annually:
Failure to meet any of the reporting requirements may result in termination of the employer's status as a self-insurer.
A self-insurer who has discontinued business in New York State, or has arranged for the payment of compensation by alternate methods (NYSIF or insurance carrier coverage), may terminate their status as a self-insurer at any time by notifying the Office of Self-Insurance. The security deposit maintained by the Board for disability and Paid Family Leave benefits may be returned 24 months after the effective date of termination of an employer's status as a self-insurer, if there are no outstanding compliance issues.